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Weight Loss Surgery for Diabetes Patients – A Problematic Choice

With obesity rates in the United States and around the world continuously rising, surgery for weight loss is becoming an ever more acceptable option. Now, two clinical studies suggest that diabetics can benefit from operations as well. Type 2 (or adult-onset) diabetes is mostly linked to weight problems and has reached similarly epidemic proportions. According to the Centers for Disease Control and Prevention, the number of diabetes cases has nearly tripled over the last three decades and affects today more than 20 million Americans.

Both study reports – one from Italy, the other from the United States – concluded that surgical procedures, a.k.a. bariatric surgery, by which the size of the stomach is considerably reduced, enabled patients not only to lose weight but also manage their blood sugar levels more effectively than traditional measures like dieting and medication. Bariatric Surgery Can Carry Great Risks, Including Malnutrition

The findings, which were published in the New England Journal of Medicine, may change how many diabetes cases will be treated in the future. Proponents of bariatric surgery say the studies confirmed that stomach size reduction should no longer be seen as a last resort but should be considered earlier in the treatment of obese patients with type 2 diabetes. Others warned that more studies are needed and that the risks in connection with the procedures available today remain high.

According to the American Society for Metabolic and Bariatric Surgery (ASMBS), about 200,000 surgical procedures for weight loss are performed annually in the U.S. The National Institute of Health (NIH) says that surgery should only be recommended for people with a body mass index (B.M.I.) of over 40, or over 35 for those with diabetes and other serious illnesses related to weight problems.

For the studies, the researchers limited themselves to three types of weight loss surgery: Roux-en-Y, biliopancreatic diversion and sleeve gastrectomy. Roux-en-Y is the most commonly applied method of gastric bypass surgery, by which a small part of the stomach is sealed off and then directly connected to the small intestine. Biliopancreatic diversion removes large parts of the stomach and bypasses the majority of the small intestine as well, which limits both food intake and absorption of nutrients. Sleeve gastrectomy reshapes the stomach into a smaller tube but does not alter the way food enters or leaves it.

Needless to say, these are all very drastic steps to prevent weight gain and a host of diseases that often go with it, including diabetes, heart disease, hypertension, high cholesterol and so forth.

As a dietitian, my greatest concern is how the anatomical changes affect the metabolism of patients. Because bariatric surgery limits food intake so dramatically and also diminishes the absorption of nutrients, there is a great risk of malnutrition. Especially a sufficient supply of protein, which is extremely important during rapid weight loss for overall health and to allow for proper healing from the surgery, can become hard to obtain. Part of the reason for this is that the initial digestion of proteins takes place in the stomach, which after surgery is not only reduced in size but also in capacity. Even more problematic is the hindered absorption of essential nutrients in the small intestine because some or much of it is bypassed. This affects the absorption of carbohydrates, proteins and fats but also vitamins and minerals. Potential complications, not only from the surgical procedure itself but also from the nutritional deficiencies, are multiple.

Bariatric surgery should never be considered as a quick fix, on par with cosmetic surgery. It is a profound alteration of the digestive system that is risky and requires permanent changes in diet and lifestyle choices. Intensive post-operational counseling and strict observation of nutritional guidelines are an absolute must.

Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” (http://www.timigustafson.com), and at amazon.com. You can follow Timi on Twitter and on Facebook.

Note: This is a seattlepi.com reader blog. It is not written or edited by the P-I. The authors are solely responsible for content. E-mail us at newmedia@seattlepi.com if you consider a post inappropriate..